Health Insurance Reform and Medical Costs

America's Affordable Health Choices Act takes a number of steps to ensure that when Americans face a health crisis, they don't also face a financial crisis. Yesterday, Speaker Pelosi and Reps. Xavier Becerra, Donna Edwards, Rosa DeLauro, and Mary Jo Kilroy held a press conference on the critical need to address crushing health care costs.

A recent study published in the American Journal of Medicine showed two out of three personal bankruptcies in 2007 were a result of medical debt, even though more than 75% of those bankrupted had private health insurance. House Democrats were joined by four Americans who have worked hard and played by the rules only to end up with crushing health care costs and debt. Vernon Le Count of Maine has tens of thousands of dollars in medical debt because his health insurance had a waiting period and a high deductible, Molly Secours of Nashville has medical debt from uterine cancer that could result in foreclosure on her home, and Catherine Howard of San Francisco and Jaclyn Michalos of Massachusetts both beat cancer but had radically different experiences with their health insurance:

Molly Secours:

Thank you. Good morning. Again, my name is Molly Secours.

Until about two years ago, I was a fairly healthy free-lance filmmaker. I prided myself on being responsible, a responsible single, self-employed person. And I did the smart thing. I went out, I got a low-end health care policy with a large deductible — it was a catastrophe insurance policy. I told my friends that it was my bus insurance, in case I got hit by a bus. And that's pretty much how I felt. And I was pretty healthy, so that was safe.

I know that might sound dramatic, you know, the “in-case I get hit by a bus insurance policy,” but I'm a filmmaker and what happened to me sometimes feels more like a movie than actually my life.

Two years ago last month, I got hit by the “bus.” I heard those words, the three most terrifying words that you can hear in America: “You have cancer.” When you hear those words, it's like stepping out of the shower into outer space. You're disoriented — none of the normal rules apply of life, of the universe, everything becomes surreal — “This can't be happening. Not to me. How?”

And when I finally found my tongue and the first things out of my mouth were: “I know I can't afford this.” Never mind that it was stage four uterine cancer and it had spread to the lymph nodes already, it was requiring an immediate, radical hysterectomy, and that I was facing that I was no longer going to have the possibility of having children. The first words were: “But I can't afford this.” Never mind that there was a harrowing chemo cocktail and radiation cocktail that I was about to endure for the next six to eight months of my life that meant that I would never be the same, I was consumed with the fear that I'll have to declare bankruptcy. Never mind that I was being told that the key to my recovery was to remain stress-free, just stay stress-free and all I could hear was: “I'll probably lose my house. And so my health care nightmare began.”

The legal cocktail of chemo required these mega anti-nausea drugs and they were $500 a shot — $500 a round for each chemo. I had six rounds of chemo. I had to call cousins in Canada to see if I could get it cheaper because I couldn't afford it because my insurance company wouldn't pay for the chemo drugs — the anti-nausea drugs. After the first five rounds of chemo, I got the first bill in the mail. It was a four-page itemized bill and one item on the bill for the first round of chemo, the first of six, was for a shot of Neulasta, which was almost $6,000. That was one item on a four-page bill. And I about passed out knowing that just $36,000 I was going to have to look forward to receiving in the mail of bills just for that one shot. So some days when I got the bills in the mail, that was almost as excruciating as the harrowing chemo treatments that I went through. And there were days when I prayed that I wouldn't make it, because I didn't want to face what was waiting for me on the other side, should I make it.

But I survived cancer and last fall, less than a year in remission, I had to battle with my mortgage company who had put me into foreclosure. Even though I'd never been late, I'd never missed a payment during the entire time of chemo and radiation. There was no leniency because I had cancer. I had a subprime mortgage because I am self-employed. And if it weren't for the fact that I knew Tennessee Congressman Jim Cooper, I wouldn't have a home right now. They rallied for me, the press rallied for me, and I ended up getting to keep my house. So I didn't lose my house, but it shouldn't take an act of Congress for someone who has cancer to keep their house.

So I tell you this today, being 15 months in remission knowing that my continued recovery depends on keeping my stress low as I chip away at tens of thousands of dollars that my health insurance company didn't cover. And it wasn't that I wasn't responsible. I did the right thing. I bought the insurance. I bought the insurance with a major carrier and still it wasn't enough to prevent me from nearly losing my home. And now that very same policy has doubled and I'm terrified to get another one because I know that now that I have cancer I am a marked woman.

There are 47 million people without insurance in this country and they're not looking for a handout. There are thousands of people like me who have insurance and they're not looking for a handout — we're not looking for a handout. What we're looking for, what we're asking for, what we're begging for, what I'm begging for — is a current health reform package that becomes law so that people like me can receive adequate health care and aren't fiscally and physically ruined by getting a diagnosis of cancer. Thank you very much.

Vernon Le Count:

My name is Vernon Le Count. I am here today from the small town of Freedom, Maine.

Unlike many stories you hear, my medical bills aren't from a single illness or an action, but accumulated over the past decade. In 1999, while completing a waiting period for benefits to kick in on a new job, I was admitted to a hospital for kidney stones. If you've ever had kidney stones, you know that you don't want to wait for your insurance to kick in. [Laughter.] But the operation was done twice — incorrectly the first time and correctly the second time. I ended up with a total of $12,000 in debt to the hospital plus another $6,000 to the doctor — way beyond my budget.

Since then, I've been fortunate, and I have health insurance for most of the last 10 years. But as is common in Maine, I've mostly worked for small businesses or been self-employed. The health insurance premiums I and my employer were able to afford came with high deductibles that I could not meet. It's usually about $3,000-$5,000 a year. Even though I'm healthy, I find there's always something that causes me to max out my deductible. This year I had a colonoscopy, which is standard for a person my age, added onto my deductible. Between the initial bill for the kidney stones and years of high deductibles, I know owe the hospital $28,000 and over $8,000 to doctors. I pay toward this debt each month, but I can't make a dent in it, obviously. And this is on top of the thousands I pay currently for my health care premiums and co-pays, which is about a third of my income goes to health premiums and co-pays.

I'm trying to do the right thing, so I pay my bills down every month, but they accumulate faster than I can pay. But this story is not unusual. Typical Maine workers, like farmers, fisherman, loggers, carpenters, and seasonal workers, are usually self-employed and need to follow the work when it is available. They need portability between employment chances and affordable options, like the public plan. We need protection from this kind of crushing debt, the kind of protection that the House health care reform bill offers. We need to get rid of things like waiting periods so that no one is left in a lurch like I was. We need portability to health care between jobs and more affordable options. Portability and affordability. We need to do this as soon as possible. Please. Thank you.

Catherine Howard:

Hi. My name is Catherine Howard and I'm from San Francisco. Five years ago, I was working as a documentary film producer. I wasn't making a lot of money, but I knew that maintaining my health insurance was really important. I was afraid I'd get hurt snowboarding, not dealing with a life-threatening illness. I found a private insurance plan, that seemed affordable — only $140 a month — but I had no idea what it would really cost me. After my breast cancer diagnosis I thought I was covered. I had done the right thing; I had insurance.

But I discovered that the health plan that I was paying for didn't cover a large part of the cancer care that I required. I had chosen one of those low premium, but high deductible plans. And I had to pay for 30 percent of all the services that the policy covered. And it didn't even cover all the services I needed. I remember staring at the needle of one shot. It cost $2,100, and thinking, “I have to pay 600 dollars for this today.”

Ultimately I wound up $100,000 in debt, between the medical expenses and the living expenses for while I was sick. I've been paying it off slowly, using payment plans and my credit cards. But I still owe $40,000 just for medical costs. Rather than saving money for a down payment on a house, buying a car, or even having a savings account, I spent $1,800 a month, basically every penny I have after the basics to pay off what I owe. I lived like a pauper to pay this and I don't know where the end of this is.

The kind of health reforms in the House proposal would have kept me out of this devastating debt and the financial circumstances that I'm now in. Despite my own best efforts, I'm fortunate that my employer now covers comprehensive health insurance because as a cancer survivor, otherwise I'm completely uninsurable. People like me, working to build our careers, we need a real choice for affordable, reliable coverage. Thank you.

Jaclyn Michalos:

Good morning, my name is Jaclyn Michalos. I'm from Massachusetts. Thank you for having me here today, and my story is a little different from Catherine's.

I never imagined that I could get breast cancer at the age of 27. After graduating college, I taught pre-school for three years and had health insurance, but in 2005, I left my job to work for my father at his restaurant in Randolph, Mass. As a small, family-owned business, he couldn't afford to provide insurance, so I became uninsured. In 2006, I discovered a lump in my breast. I called my doctor to see what it would cost me to see her and she told me it would be $130 out of pocket. She checked me out and told me it was nothing to worry about, I didn't get a mammogram or any other test. I can't help but believe that me not having health insurance affected that decision.

Then Massachusetts started its new health insurance program that requires everyone to get health insurance. I was happy to, but on my waitress wages, I couldn't afford it, so I was able to get CommonHealth care. I was still worrying about the lump that hadn't gone away, so I went to see another doctor who had ordered an ultra-sound, a mammogram, a biopsy and I ultimately ended up being diagnosed with breast cancer.

On July 24, 2007, I got a double mastectomy and reconstructive surgery. The bills totaled about $125,000, a cost we would not have been paid without my parents taking out a second mortgage on their home which would have threatened their financial security as well. But I was able to focus on getting through the treatment and getting well — not on how we would possibly pay the larger bill. If it hadn't been, if I hadn't had insurance, I probably would not have made the doctor's appointment and gotten the test that turned out to be cancer and I might not be alive today to tell my story. Instead, tomorrow will be my two-year anniversary of being cancer free.

I want every woman like Catherine and Molly, and every American like Vernon to know that if you get sick, you will be able to get the care you need without having to waste precious energy on worrying about losing your home, or becoming in debt for the rest of your life. I am not a member of any activist group. I don't pay a whole lot of attention to politics. I just try to work hard and make a good life. It makes me sad and angry to hear people try to politicize this and it is about our health and our well being. Please keep focused on something getting done sooner rather than later. Unlike Catherine, I am a relatively lucky person because my state did this. It is an American problem and it needs to be an American solution. Thank you.